New rehab laws may revamp addiction treatment in California

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Tammy Smick of Downey, sits in the bedroom of her son, Alex, who died in 2012 from a lethal combination of prescription medications while being treated at an Orange County drug treatment center. Several laws signed this week by Gov. Jerry Brown would impose more regulations on the rehab industry. (Photo by Nick Agro, Orange County Register/SCNG)

Sergius Harty, 25, a homeless heroin addict from Chicago, shows off scars he says were caused from Necrotizing Fasciitis, or “skin-eating” disease. (Photo by Mindy Schauer, Orange County Register/SCNG)

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Forensic scientist Terry Baisz shows pills masking as other pharmaceutical drugs but they are actually Fentanyl at the Orange County Sheriff’s Department crime lab MICHAEL GOULDING, ORANGE COUNTY REGISTER

Timmy Solomon peers into his tent which is under a tree near a busy San Clemente corner in April, 2017. (Mindy Schauer, Staff File)

In April 2017 Timmy Solomon’s mood swings between euphoria and sadness after shooting heroin and crystal meth, a concoction named “goofball.” (Mindy Schauer, Staff File)

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A lethal dose of heroin compared to a lethal dose of fentanyl (Bruce A. Taylor-Criminalist II/NH State Police Forensic Lab)

Gov. Jerry Brown signed a raft of bills into law Wednesday that will begin imposing order on the Wild Wild West of California’s addiction treatment system.

Most take small steps in what reformers say is the right direction – toward stronger regulation. But one of the new laws could be a game-changer, forcing fundamental revisions in the kind of care offered to substance users.

That bill is SB 823, by Sen. Jerry Hill, D-San Mateo, which requires licensed rehabs in California to adopt the American Society of Addiction Medicine’s treatment criteria as the minimum standard of care.

“It’s an unbelievably unregulated field, and we’re going to try to put our arms around that by requiring some standards and the best scientific evidence before these facilities are licensed,” said Hill. “We may be able to solve a small part of the problem, and save some lives.”

The overwhelming majority of California’s nearly 2,000 licensed treatment centers are non-medical – meaning they’re based on the 12-step model of Alcoholics Anonymous rather than on medical science, which recommends drugs like buprenorphine to curb opioid cravings and other medical treatments to battle other types of addiction.

Some treatment centers and sober living homes reject the medical approach entirely, refusing to accept clients who take medication to manage addiction, and never present medication as a treatment option. Instead, they adhere to a philosophy of total abstinence. Studies have shown that non-medical treatments are successful less than 10 percent of the time.

In contrast, the success rate for people in medically-managed opioid treatment is 60 to 90 percent, according to the California Society of Addiction Medicine.

“I think this is going to have far-reaching implications – specifically, greater use of medication to treat addiction, a greater presence of addiction medicine professionals in the equation, and certainly, more appropriate placement of patients,” said David Kan, a psychiatrist and president of the California Society of Addiction Medicine, which championed the bill.

“This holds promise. Standards are critical. Without standards, people can do what they want,” Kan added. “I see this as an advance for the health of Californians, and it was a great call by the governor to sign it.”

The state has five years to figure out how to implement the new law.

Imposing order

Many rehab-related bills were watered down or condemned to death in committee during this session, frustrating some reformers. But other people interested in changing the industry — which is widely seen as under-regulated — are encouraged that Brown signed as many bills into law as he did.

One of the laws Brown signed is SB 1228 by Sen. Ricardo Lara, D-Bell Gardens. It forbids licensed rehabs and addiction professionals from patient-brokering, a practice in which a rehab pays patients to come to a particular facility and stay there for the purpose of billing their insurer. Centers that do pay for patients — or those that pay independent agents to bring them patients — can be fined or lose their license.

Originally, the bill also aimed to raise standards for sober living homes. It stops short of imposing criminal charges on patient-brokering, and the fines aren’t as hefty as those imposed in Florida, where patient brokering can cost a rehab operator as much as $500,000. But it’s a firm step in the right direction, according to activist Ryan Hampton.

“Now we have legislative intent and precedent to address this issue in a larger context,” Hampton said. “We’re going to continue to build on this success in the next session and in the future. We will get the the point where we have full protections in place. At least we’re not going backwards.”

A new law that aims to train a more watchful eye on new rehabs is AB 3162, by Assembly members Laura Friedman, D-Glendale, Melissa Melendez, R-Lake Elsinore, Sharon Quirk-Silva, D-Fullerton, and Sen. Pat Bates, R-Laguna Niguel. It makes rehab licenses provisional for one year and revocable for good cause.

SB 992, by Sen. Ed Hernandez, D-West Covina, aims for transparency and a safety net for patients who relapse while in treatment.

It requires that financial relationships between sober living homes and licensed treatment centers are publicly disclosed, and requires centers to draft plans for what to do when residents relapse, including how they’d be supervised while under the influence of drugs or alcohol. Currently, those who use while in treatment are often kicked out while still high, sometimes collapsing on neighbors’ lawns.

SB 1109, by Bates, tries to tackle addiction from both the prescriber and consumer angles.

Doctors will have to take continuing medical education on the risks of opioids; prescription bottles will have to carry a warning about addiction and overdose risks; and youth sports organizations will have to highlight the risks of opioid use to each student-athlete and their parent/guardian annually.

Ongoing probe

The new laws come in the wake of the Southern California News Group’s ongoing probe of the the rehab industry in Southern California, which includes more than 1,000 centers in the region.

The investigation found that dozens of patients have died for want of proper medical care in non-medical facilities that would not be allowed to open in many other states. It also found that inexperienced and unscrupulous operators have taken advantage of mandatory mental health treatment coverage required by the Affordable Care Act, and that almost anyone, regardless of education level or criminal history, can open a licensed treatment center.

The Southern California News Group investigation also found that many rehab operators bill insurance companies hundreds of thousands of dollars per client, and that addicts with good insurance continue to be lured to the region by rehab operators who promise free airline tickets, “scholarships” that cover insurance deductibles, and cash payments to stay in treatment or agree to a particular kind of treatment.

In the wake of these revelations, the FBI has raided some treatment providers. Also, the Orange County District Attorney has formed a task force to fight rehab fraud, leading to arrests of two groups of rehab operators, physicians and drug testing centers. Hearings have been held in congress and the California Senate and, as of this week, the investigation into what is known as “Rehab Riviera” has sparked changes in California law.

“Thanks to you and the paper and John Oliver for opening my eyes to the issue and the abuses,” said Hill, whose bill will require science-based treatment at rehab centers. “Southern California has such a prevalence of these facilities. It’s not benefiting anyone, and harming so many people.”

Mark Mishek, president and CEO of the Hazelden Betty Ford Foundation, was stunned by California’s lax standards after the merger of the Minnesota and California treatment giants. He’s encouraged by the laws signed by Brown this week, saying they’re a sign that the state is starting to take addiction treatment seriously, and that there will be more enforcement.

“All welcome news,” Mishek said.

But he and others noted that implementation of Hill’s bill – 2023 – feels distant.

“The assumption is that, in the interim, the reputable centers will do an even better job and the bad places will continue to… see how long they can get away with it,” he said. “You still have unlicensed facilities out there – sober homes morph themselves into treatment centers.”

Bates, who is also running for re-election, said she plans to resurrect and refine her proposal for criminal background checks on people owning rehabs and working in the industry, with the understanding that many who have valuable first-hand experience fighting addiction will not have perfect records.

She also wants to continue to push Washington D.C. to give local governments tools so they can at least know where sober living homes are, to help ensure they’re being good neighbors.

Bates has been working on this issue for years – but this is the first year bills have made it through the Legislature, landed on the governor’s desk, and been signed into law. She credited SCNG’s Rehab Riviera coverage for raising awareness

“We wouldn’t have gotten this far without your deep dive,” Bates said. “It has been the key that unlocked the door.”

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